Perfusion-Uk最新文献

IntroductionOptimal sedation strategies for patients with respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV ECMO) are not well defined.MethodsPhysicians caring for patients on ECMO in an intensive care unit were invited to complete an international survey about sedation and analgesia practices for adult patients undergoing VV ECMO for severe Acute Respiratory Distress Syndrome (ARDS).ResultsThe survey was completed by 234 physicians, most commonly identifying as critical care (29.9%) and practicing in North America (38.9%). The Richmond Agitation Sedation Scale (88.5%) and Clinical Pain Observation Tool (40.2%) were commonly used for monitoring. Agents of choice were propofol (73.9% prior to ECMO and 56% within 48 h after initiation) and fentanyl (57.3% and 40.2%), with increasing preference for dexmedetomidine after ECMO initiation (14.5% prior to and 25.6% after initiation). Routine neuromuscular blockade use beyond 48 h after cannulation was rare (1.3%). Common strategies to reduce sedatives included sweep gas titration (74.4%) and minimizing nocturnal interventions (63.7%). Most respondents believe antipsychotics also work to this effect (57.3%).ConclusionsSedation strategies for adult ARDS patients receiving VV ECMO seem to be influenced by time from cannulation and patient factors. Future research should focus on identifying optimal sedation strategies and developing a consensus for best practice.

IntroductionPulmonary artery (PA) cannulation is emerging as a method for concurrent cardiac and respiratory failure, but limited data exists on how cannula positioning, particularly cannula tip angle, affects perfusion symmetry. Due to varying pulmonary bifurcation geometry between patients, ensuring even distribution of oxygen-saturated blood becomes critical. This computational fluid dynamics (CFD) study investigated the effects of cannula positioning and angles on oxygen delivery within the PA using 6 different configurations.MethodAn idealized PA geometry based on a CT scan was constructed including the 6 different cannula configurations: two straight (short and long) and four angled (5° and 10° toward either pulmonary branch). Simulations assumed laminar, steady-state flow at 6 L/min total (50% ECMO contribution). Oxygen transport was modeled as a passive scalar with 75% saturation from the heart and 100% from the cannula. Perfusion symmetry was quantified using the absolute difference in mean oxygen saturation (ΔSaO₂) and partial pressure (ΔpO₂) between the right (RPA) and left pulmonary arteries (LPA).ResultsCannula positioning and angulation influences oxygen distribution within the PA. Straight-tipped cannulas favored LPA-sided flow due to the natural geometry of the pulmonary artery (ΔSaO₂ = 12.9-15.1%). A 5° RPA directed angulation achieved the most symmetric distribution (ΔSaO₂ = 9.2%, ΔpO₂ = 14.2 mmHg), whereas greater or opposite angulations increased flow asymmetry.ConclusionMinor cannula tip angulation, specifically 5° deflection towards the RPA, enhances bilateral PA oxygenation without increasing ECMO flow, providing a simple yet effective strategy for optimizing pulmonary ECMO perfusion.

IntroductionDue to anticoagulation during Extracorporeal Membrane Oxygenation (ECMO), patients face a higher risk of bleeding. This study aimed to assess the correlation between anticoagulation assays and hemorrhage in ECMO patients.MethodsWe reviewed records from patients in our critical care units, comparing anticoagulation parameters with clinical outcomes. Statistical analyses included the Wilcoxon rank sum test for continuous variables and chi-square or Fisher's exact tests for categorical variables. We used Kaplan-Meier curves to depict hemorrhage incidence and logistic regression to identify factors associated with bleeding and mortality. Linear regression assessed coagulation factors linked to length of stay (LOS).ResultsOf 76 patients, 32 (42.1%) experienced hemorrhage; 15 (46.9%) of these survived. Survivors had a higher proportion without bleeding (68.2%). Hemorrhage patients had more circuit changes (18.8% vs 2.3%, p = .01). The 10-, 20-, and 30-days cumulative hemorrhage incidences were 36.9%, 58.8%, and 72.5%, respectively. Multivariable analysis suggested that bleeding patients had a higher aPTT prior to the bleeding event compared with the median aPTT in non-bleeding patients (p = 0.04), and ACT and PT levels showed a trend towards a significant association (p = 0.06). Longer ECMO runs and circuit changes increased hemorrhage risk (OR = 1.004 and OR = 12.85, respectively).ConclusionOur study found that higher aPTT and longer ECMO duration are independent hemorrhage risk factors, underscoring the need for timely ECMO decannulation.

BackgroundThe increasing digitization of perfusion practice has led to the integration of advanced data management systems (DMS) that record and analyze intraoperative variables in real time. While these systems improve accuracy, traceability, and clinical decision-making, they also expose perfusion workflows to significant cybersecurity risks. Given that perfusion data directly reflect artificial circulation, any loss of integrity or service can have immediate clinical consequences.Materials and MethodsA comprehensive narrative review was conducted to synthesize current knowledge on cybersecurity in perfusion informatics and performance. The research strategy combined systematic database searches (PubMed, Scopus, IEEE Xplore, and Web of Science) with targeted grey literature review (regulatory frameworks and institutional reports). Inclusion criteria focused on articles published between 2010 and 2024 addressing healthcare cybersecurity, perfusion informatics, and medical device security. Studies were analyzed qualitatively to identify recurring themes, technological approaches, and governance models. Reference cross-checking ensured comprehensive coverage, and terminology was standardized according to ISO/IEC 27001 principles. The review followed an integrative, non-meta-analytic design, emphasizing conceptual synthesis rather than statistical aggregation.ResultsThirty-three primary and secondary sources were identified. The literature reveals a consistent pattern of vulnerabilities across clinical DMS, with perfusion systems being particularly exposed to ransomware, data tampering, and service interruption. The review highlights the centrality of the Confidentiality-Integrity-Assurance of Service triad as a guiding model. Key strategies identified include encryption and role-based access control, blockchain audit trails, federated learning, and post-quantum cryptography. However, empirical studies focusing specifically on perfusion remain scarce, underscoring a major research gap.ConclusionsCybersecurity in perfusion informatics must evolve from a technical adjunct to a clinical mandate. Integrating security frameworks into perfusion workflows supported by legal compliance (HIPAA, GDPR, ISO 27001) and ethical governance is essential to preserve patient safety. Future research should prioritize multicenter simulations, resilience testing, and cross-disciplinary training to ensure the continuity, integrity, and trustworthiness of digital perfusion systems.

IntroductionEx vivo perfusion (EVP) in heart transplantation (HTX) enables transportation of explanted organs over longer distances as well as monitoring of cardiac metabolism under unloaded coronary perfusion, thereby expanding the possible pool of suitable donors for HTX. We aimed at identifying possibly modifiable risk factors predicting impaired outcome after HTX through analysis of perfusion parameters, donor and recipient characteristics.MethodsWe included 64 patients after HTX using EVP (TransMedics Organ Care System) between February 2010 and October 2022 in this retrospective, single-center analysis. Blood gas analyses were taken during EVP in a standardized manner.ResultsHTX recipients were 44.8 ± 16.2 years old, six patients being younger than 18 years at the time of transplantation. High urgency listing status was present in 79.7%, and 67.2% had previous cardiac surgery. Lower base excess during EVP predicted severe primary graft dysfunction (PGD) (-5.55 ± 1.95 vs -3.94 ± 2.38 mmol/L, p = 0.043). With every additional minute of warm ischemia, the risk of PGD was 3.7% higher (OR 1.037, 95% CI [1.004; 1.072], p = 0.028). Low donor serum potassium (3.4 ± 0.76 mmol/L vs 4.2 ± 0.60, p = 0.008), high glucose after EVP priming (207.63 ± 99.05 mg/dL vs 146.45 ± 51.99, p = 0.045), and resuscitation of the donor (55.6% vs 18.2%, p = 0.027) were associated with impaired survival after HTX.ConclusionsEVP provides a unique method to assess graft function during the retrieval of hearts for cardiac transplantation. Low base excess, priming glucose, warm ischemia and donor hypokalaemia influence the frequency of adverse outcomes after HTX. Future studies may address possible strategies to safely modify these risk factors.

BackgroundTwo previous clinical studies indicated veno-venous perfusion-induced systemic hyperthermia (VV-PISH), producing elevated temperatures of 42°C, induces cell death, apoptosis, or senescence of responsive cancers. The VV-PISH circuit has been refined and rebranded as Hyperthermic Extracorporeal Applied Tumor Treatment (HEATT^®).MethodsThe local IRB approved this retrospective chart review. All devices are FDA-approved. The referring physician judged each patient to be hospice-eligible with a median predicted survival of 3 months and maximum predicted survival of 6 months. We evaluated HEATT^® in hospice-eligible patients (n = 13) with unresponsive, advanced cancer, conducted at a single site, with a select, consistent team of healthcare providers (critical care, anesthesia, perfusionist, interventional radiologist, HEATT^® consultant). HEATT^® treatment (42°C for 120 min) was delivered once between June 2021 and April 2022. The referring physician followed patients until documented death. HEATT circuit and criteria were refined to maximize safety.ResultsIn a retrospective chart review of the 13 consecutive patients, 8/13 patients exceeded expected median survival, 6/13 exceeded the 6-months predicted end-of-life, and 5/13 exceeded 12 months. Lessons learned allowed the refinement of inclusion/exclusion criteria of Karnofsky >70, ability to ambulate, and age <80. Likewise, refining the circuitry led to improved standardization of the HEATT^® perfusion technique and management.ConclusionsThis consecutive series of 13 hospice-eligible patients demonstrated the refinement of HEATT^®, focusing on perfusion technique and selection criteria. In this small series of physician-referred hospice-eligible patients unresponsive to conventional therapy or other integrative oncology treatments, HEATT^® demonstrated safety with an increase in the length of survival over median expected in eight of 13 patients, with five of 13 patients living 12 to 18 months, 2-3 times longer than the referring physician expected. These refinements are essential to enable prospective randomized trials of like-patient populations to generate evidence-based medical recommendations.

IntroductionContinuous retrograde cardioplegia worsens surgeon's vision while performing distal anastomosis in coronary artery bypass grafting operations. We investigated whether intermittent retrograde cardioplegia, which provides a bloodless surgical field by interrupting cardioplegia flow during distal anastomosis, poses a disadvantage in terms of myocardial protection.MethodsThis retrospective study was conducted in two different heart centres between January 2013 and July 2023. A total of 234 patients who underwent ≥2 target vessel revascularization under cardiopulmonary bypass were examined. Isothermic, potassium-enriched blood cardioplegia was used and induction was performed antegrade in all patients. In addition to antegrade, we routinely gave retrograde cardioplegia. Retrograde cardioplegia was applied continuously with the force of gravity in the continuous group (n = 167), and intermittently with pressure in the intermittent group (n = 167).ResultsThe volume of cardioplegia solution administered was significantly higher in the intermittent group compared to the continuous group (4070 ± 760 mL vs 3190 ± 575 mL; p = 0.001). However, no significant differences were observed between the groups regarding postoperative clinical outcomes or early mortality rates.ConclusionsIntermittent retrograde cardioplegia offers superior operative conditions by ensuring a bloodless surgical field and improved procedural comfort, while maintaining equivalent efficacy in myocardial protection compared with the continuous method.

Sweep gas nitric oxide (sNO) is emerging as an adjunctive therapy, which may have positive impacts on thrombosis and inflammation during ECMO treatment. sNO is administered to the gas phase of the ECMO oxygenator with the aim of reducing contact activation of blood when flowing through and over artificial surfaces. NO delivery devices have gas flow requirements that are above the sweep gases requirements of smaller patients supported on ECMO. To facilitate sNO delivery in patients requiring a sweep flow rate below the required bias flow rate of NO delivery devices, varying sNO delivery setups have been described. Here, we describe three systems for safe and reliable sNO delivery.

IntroductionVentricular assist devices (VADs) have emerged as essential tools for stage D heart failure, improving survival and quality of life by serving as a bridge to transplant, destination therapy, or bridge to decision. The successful implantation and management of VADs requires a multidisciplinary team, in which perfusionists have a critical role in ensuring proper oxygen delivery, hemodynamic support, and the smooth transition from extracorporeal support to the implanted device. The objective was to describe the institutional perfusion protocol for LVAD implantation and to characterize intraoperative perfusion parameters at a Latin American referral center.MethodsA retrospective observational cohort study was conducted including all patients who underwent LVAD implantation at a referral center in northeastern Colombia. Statistical analysis involved the use of descriptive statistics.ResultsA total of 33 patients underwent LVAD implantation, with a median age of 54 years and 51.52% of male. Ischemic cardiomyopathy was the leading etiology (27.27%). The median cardiopulmonary bypass (CPB) time was 153 min (IQR: 128-181). During cardiopulmonary bypass the median lactate levels were 1.8 mmol/L (IQR: 1.5-2.2), and the cardiac index ranged from a minimum CI of 2.3 to a maximum CI of 2.6 L/min/m².ConclusionsThis study highlights the vital role of cardiopulmonary perfusion in the successful implantation of long-term LVADs in advanced heart failure patients. Optimal intraoperative management, including controlled temperature, low lactate levels, and optimal cardiac index, emphasizes the need for standardized strategies and the expertise of perfusionists.

IntroductionThe benefits of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for patients with acute respiratory distress syndrome (ARDS) are well established. However, cannulation-related vascular complications, while rare, can be life-threatening.Case ReportAn 82-year-old man with ARDS caused by pleural empyema and lung abscess required VV-ECMO for worsening acidemia and hypoxemia. During internal jugular vein cannulation, a purulent effusion abruptly emerged from the outflow catheter. CT revealed catheter perforation of the brachiocephalic vein with fistulization into the pleural empyema. ECMO support was re-established using an alternative configuration. Following surgical repair, the patient gradually recovered to ambulatory discharge.DiscussionCatheter penetration into a pleural empyema in the absence of congenital anomalies is extremely rare. Here, inflammation-related vascular fragility likely contributed. This highlights the importance of considering intrathoracic pathology when determining ECMO configuration.ConclusionPleural empyema may predispose patients to vascular complications associated with VV-ECMO. A tailored ECMO configuration is essential.